Portfolio Stfm Denver 2009 Sp51 Fujinuma, Okada
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42nd STFM Annual Spring Conference Friday, May 1, 2009 3:30 PM SP51:
The Showcase Portfolio: Empowering the Residents to Build Their Own Personal Medical Home Yasuki Fujinuma, MD
Tadao Okada, MD, MPH, FAAFP, DABFM
Family Medicine Residency Program Tokyo. Centre for Family Medicine Development, HCA-JCCU
Family Medicine Residency / Department of Family Medicine Kameda Family Clinic Tateyama HANDS-FD fellowship
our claim • There is not much evidence for use of portfolio as summative assessment tool especially in postgraduate training. • At this point, it’s best used as formative assessment tool, communication tool and own value clarifying tool. • Then why not use more creatively! 2
Background • Family medicine in Japan is still in early development • Accreditation of residency program by Japanese Academy of FM started in 2006 (37 programs), now 81 (half with no residents) • The first speciality board exam will be held in July, 2009 3
Program Location
CFMD-FMR est. in 2006 Tokyo
KFCT-FMR est. in 2000 4
Definition Portfolio “A purposeful collection of student work that exhibits to the student (and/or other) the student’s efforts, progress, or achievement in (a) given area(s). This collection must include student participation in selection of portfolio content; the criteria for selection; the criteria for judging merit, and evidence of student reflection.”
Showcase Portfolio the portfolio representing the resident’s selection of their best work, to use for evaluation of competency in specific areas (vs growth model)
•Reckase, M.D. (1995). Portfolio assessment: a theoretical estimate of score reliability. Educational
5
Measurement: Issues and Practice 14: 12•O'Sullivan et al. Portfolios as a novel approach for residency evaluation. Academic Psychiatry (2002) vol. 26 (3) pp. 173-179
Showcase model growth model
•Dannefer and Henson. The por1olio approach to competency‐based assessment at the
6
Cleveland Clinic Lerner College of Medicine. Acad Med (2007) vol. 82 (5) pp. 493‐502 •COMPETENCY‐BASED LEARNING PORTFOLIO ADVISORY COMMITTEE. STATUS REPORT TO ACGME BOARD OF DIRECTORS EXECUTIVE COMMITTEE, EXECUTIVE COMMITTEE MEETING NOVEMBER 30, 2006 CHICAGO, ILLINOIS
Evidence on Portfolio • ”We were not able to identify any studies of portfolios that specifically sought to measure the ACGME general competencies” • ”Evidence to date, in studying unstructured portfolios, has demonstrated the difficulty in achieving what is typically considered acceptable standards of reliability and validity in educational measurement” • raters had good reliability for judging the overall quality of a portfolio but poor agreement on specific topics •Lurie et al. Measurement of the general competencies of the accreditation council for graduate medical
7
education: a systematic review. Academic medicine : journal of the Association of American Medical Colleges (2009) vol. 84 (3) pp. 301-9 •Carraccio and Englander. Evaluating competence using a portfolio: a literature review and web-based application to the ACGME competencies. Teaching and learning in medicine (2004) vol. 16 (4) pp. 381-7 •O'Sullivan et al. Demonstration of portfolios to assess competency of residents. Advances in health sciences education : theory and practice (2004) vol. 9 (4) pp. 309-23
Different Priorities • CFMD-FMR •
8
non selective urban outpatient clinic
• KFCT- FMR •
quality first / EBM
•
emphasis of women’s heath / maternity care
•
high-quality home care
•
child health
•
chronic care model
•
theoretical basis of family medicine
•
personal medical home
•
health promotion / COPC
Entry requirements (CFMD-FMR) 1.
Biopsychosocial model
13.
immunization
2.
Family oriented care
14.
well child visit
3.
Community oriented care
15.
common disease and referral in children
4.
Disease prevention / Health Promotion
16.
palliative care of home visit patients
5.
Continuity of care
17.
acute care of home visit patients
6.
Medical Home
18.
7.
Structure of consultation
introduction of home visit and case management
19.
care of frail elderly in the outpatient
20.
team based care and leadership
21.
medical education
22.
QI project
23.
SEA (significant event analysis)
8.
9
Care of DM
9.
Care of dementia
10.
Chronic disease guideline
11.
Chronic care model
12.
EBM
Entry requirements (KFCT-FMR)
10
1.
Coordination and accessibility
2.
Health Promotion
12.
Comprehensive community care / COPC / determinants of health *
13.
Comprehensive approach to multiple problems *
14.
Realization of new FM concepts with empowering others / team based approach (Patient-Centered Medical Home or Chronic disease management）
3.
EBM
4.
Structure of consultation (videotaping) #1
5.
Biopsychosocial Model *
6.
Women’s health / maternity care
7.
Approach to behavior change *
15.
Continuity of care with family orientation*
8.
Home care (introduction or palliative care)
16.
9.
Living in the community / service to the community
Care of underrepresented population (improving access or tailored care)
17.
evidence based CQI
10.
Comprehensive care of the elderly
18.
Structure of consultation (videotaping) #2
11.
High standard professionalism / clinical ethics
* required for board certification in FM
Reason to incorporate portfolio • In the process of defining entry area, • the faculty have to face with their own value and idea about how family physician should live and practice • the residents will know what priorities / values the program embrace. • learners will be the center of decision making about what their own learning outcomes are 11
Things to consider • What areas should be included as entries in YOUR program ? • How do you integrate uniqueness of your program with ACGME competency requirement ? (it misses some of SBP, PBLI if not careful) •Jarvis et al. Can one portfolio measure the six ACGME general competencies?. Acad Psychiatry (2004) vol. 28 (3) pp. 190-6
12
Collaboration ?
• Tadao Okada • [email protected] • Yasuki Fujinuma • [email protected]
13
copyright info
14
•
http://creativecommons.org/licenses/by-nc-nd/3.0/
•
http://creativecommons.org/licenses/by-nc-nd/3.0/deed.ja
accepted abstract Citation info SP51 The Showcase Portfolio: Empowering the Residents to Build Their Own Personal Medical Home Tadao Okada, MD, MPH; Yasuki Fujinuma, MD Portfolio is a relatively new method of evaluation introduced with ACGME outcomes project in the U.S. “The showcase portfolio” suggested by OʼSullivan et al is one of the unique type of portfolios. It really encourages us to critically reflect upon our own core values as family physicians and to promote the process of crystallization of our philosophy into everyday work. As it requires extensive dialogue among the educators and the learners in order to determine “the area of entry” for the showcase portfolio, we consider it is as an effective teaching strategy especially for creating their unique personal medical home (instead of an evaluation tool). We will review the concept of “the showcase portfolio” and discuss how to successfully implement it in the participantsʼ own program.
15
Citation: Tadao OKADA, Yasuki Fujinuma. Poster: ‘SP51 The Showcase Portfolio: Empowering the Residents to Build Their Own Personal Medical Home’ 42nd. STFM Annual Spring Conference. Society of Teachers of Family Medicine. Denver, CO, USA. April 29-May 3, 2009
解説 •
現在のところポートフォリオについての総括的評価としてのエビデン スは特に卒後教育においてはほとんど存在しません。
•
むしろ、自分たちの価値観の確認や、プログラムのカラーを内部や外 部に明確に提示したり、指導医と研修医との対話に用いるなどの目的 で使用するほうが、有意義で価値があると考えられます。
•
ですから、既存のエントリー項目などにとらわれず、｢自分たちらし さ」を出すことを考慮してみましょう。
•
家庭医療のコンテキストにおいては、多くのプログラムが、自分たち 独自のエントリー項目を設定することで、それらの分析から｢家庭医 療のコアコンピテンシー」の構築が可能になると考えられます。
16
The Showcase Portfolio: Empowering the Residents to Build Their Own Personal Medical Home Yasuki Fujinuma, MD
Tadao Okada, MD, MPH, FAAFP, DABFM
Family Medicine Residency Program Tokyo. Centre for Family Medicine Development, HCA-JCCU
Family Medicine Residency / Department of Family Medicine Kameda Family Clinic Tateyama HANDS-FD fellowship
our claim • There is not much evidence for use of portfolio as summative assessment tool especially in postgraduate training. • At this point, it’s best used as formative assessment tool, communication tool and own value clarifying tool. • Then why not use more creatively! 2
Background • Family medicine in Japan is still in early development • Accreditation of residency program by Japanese Academy of FM started in 2006 (37 programs), now 81 (half with no residents) • The first speciality board exam will be held in July, 2009 3
Program Location
CFMD-FMR est. in 2006 Tokyo
KFCT-FMR est. in 2000 4
Definition Portfolio “A purposeful collection of student work that exhibits to the student (and/or other) the student’s efforts, progress, or achievement in (a) given area(s). This collection must include student participation in selection of portfolio content; the criteria for selection; the criteria for judging merit, and evidence of student reflection.”
Showcase Portfolio the portfolio representing the resident’s selection of their best work, to use for evaluation of competency in specific areas (vs growth model)
•Reckase, M.D. (1995). Portfolio assessment: a theoretical estimate of score reliability. Educational
5
Measurement: Issues and Practice 14: 12•O'Sullivan et al. Portfolios as a novel approach for residency evaluation. Academic Psychiatry (2002) vol. 26 (3) pp. 173-179
Showcase model growth model
•Dannefer and Henson. The por1olio approach to competency‐based assessment at the
6
Cleveland Clinic Lerner College of Medicine. Acad Med (2007) vol. 82 (5) pp. 493‐502 •COMPETENCY‐BASED LEARNING PORTFOLIO ADVISORY COMMITTEE. STATUS REPORT TO ACGME BOARD OF DIRECTORS EXECUTIVE COMMITTEE, EXECUTIVE COMMITTEE MEETING NOVEMBER 30, 2006 CHICAGO, ILLINOIS
Evidence on Portfolio • ”We were not able to identify any studies of portfolios that specifically sought to measure the ACGME general competencies” • ”Evidence to date, in studying unstructured portfolios, has demonstrated the difficulty in achieving what is typically considered acceptable standards of reliability and validity in educational measurement” • raters had good reliability for judging the overall quality of a portfolio but poor agreement on specific topics •Lurie et al. Measurement of the general competencies of the accreditation council for graduate medical
7
education: a systematic review. Academic medicine : journal of the Association of American Medical Colleges (2009) vol. 84 (3) pp. 301-9 •Carraccio and Englander. Evaluating competence using a portfolio: a literature review and web-based application to the ACGME competencies. Teaching and learning in medicine (2004) vol. 16 (4) pp. 381-7 •O'Sullivan et al. Demonstration of portfolios to assess competency of residents. Advances in health sciences education : theory and practice (2004) vol. 9 (4) pp. 309-23
Different Priorities • CFMD-FMR •
8
non selective urban outpatient clinic
• KFCT- FMR •
quality first / EBM
•
emphasis of women’s heath / maternity care
•
high-quality home care
•
child health
•
chronic care model
•
theoretical basis of family medicine
•
personal medical home
•
health promotion / COPC
Entry requirements (CFMD-FMR) 1.
Biopsychosocial model
13.
immunization
2.
Family oriented care
14.
well child visit
3.
Community oriented care
15.
common disease and referral in children
4.
Disease prevention / Health Promotion
16.
palliative care of home visit patients
5.
Continuity of care
17.
acute care of home visit patients
6.
Medical Home
18.
7.
Structure of consultation
introduction of home visit and case management
19.
care of frail elderly in the outpatient
20.
team based care and leadership
21.
medical education
22.
QI project
23.
SEA (significant event analysis)
8.
9
Care of DM
9.
Care of dementia
10.
Chronic disease guideline
11.
Chronic care model
12.
EBM
Entry requirements (KFCT-FMR)
10
1.
Coordination and accessibility
2.
Health Promotion
12.
Comprehensive community care / COPC / determinants of health *
13.
Comprehensive approach to multiple problems *
14.
Realization of new FM concepts with empowering others / team based approach (Patient-Centered Medical Home or Chronic disease management）
3.
EBM
4.
Structure of consultation (videotaping) #1
5.
Biopsychosocial Model *
6.
Women’s health / maternity care
7.
Approach to behavior change *
15.
Continuity of care with family orientation*
8.
Home care (introduction or palliative care)
16.
9.
Living in the community / service to the community
Care of underrepresented population (improving access or tailored care)
17.
evidence based CQI
10.
Comprehensive care of the elderly
18.
Structure of consultation (videotaping) #2
11.
High standard professionalism / clinical ethics
* required for board certification in FM
Reason to incorporate portfolio • In the process of defining entry area, • the faculty have to face with their own value and idea about how family physician should live and practice • the residents will know what priorities / values the program embrace. • learners will be the center of decision making about what their own learning outcomes are 11
Things to consider • What areas should be included as entries in YOUR program ? • How do you integrate uniqueness of your program with ACGME competency requirement ? (it misses some of SBP, PBLI if not careful) •Jarvis et al. Can one portfolio measure the six ACGME general competencies?. Acad Psychiatry (2004) vol. 28 (3) pp. 190-6
12
Collaboration ?
• Tadao Okada • [email protected] • Yasuki Fujinuma • [email protected]
13
copyright info
14
•
http://creativecommons.org/licenses/by-nc-nd/3.0/
•
http://creativecommons.org/licenses/by-nc-nd/3.0/deed.ja
accepted abstract Citation info SP51 The Showcase Portfolio: Empowering the Residents to Build Their Own Personal Medical Home Tadao Okada, MD, MPH; Yasuki Fujinuma, MD Portfolio is a relatively new method of evaluation introduced with ACGME outcomes project in the U.S. “The showcase portfolio” suggested by OʼSullivan et al is one of the unique type of portfolios. It really encourages us to critically reflect upon our own core values as family physicians and to promote the process of crystallization of our philosophy into everyday work. As it requires extensive dialogue among the educators and the learners in order to determine “the area of entry” for the showcase portfolio, we consider it is as an effective teaching strategy especially for creating their unique personal medical home (instead of an evaluation tool). We will review the concept of “the showcase portfolio” and discuss how to successfully implement it in the participantsʼ own program.
15
Citation: Tadao OKADA, Yasuki Fujinuma. Poster: ‘SP51 The Showcase Portfolio: Empowering the Residents to Build Their Own Personal Medical Home’ 42nd. STFM Annual Spring Conference. Society of Teachers of Family Medicine. Denver, CO, USA. April 29-May 3, 2009
解説 •
現在のところポートフォリオについての総括的評価としてのエビデン スは特に卒後教育においてはほとんど存在しません。
•
むしろ、自分たちの価値観の確認や、プログラムのカラーを内部や外 部に明確に提示したり、指導医と研修医との対話に用いるなどの目的 で使用するほうが、有意義で価値があると考えられます。
•
ですから、既存のエントリー項目などにとらわれず、｢自分たちらし さ」を出すことを考慮してみましょう。
•
家庭医療のコンテキストにおいては、多くのプログラムが、自分たち 独自のエントリー項目を設定することで、それらの分析から｢家庭医 療のコアコンピテンシー」の構築が可能になると考えられます。
16
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